Sclerotherapy - a method of application specific products - sclerosants - to cause varicose vein in the process of fibrosis and sclerosis, which resulted in abnormal Vienna just fused.
As you know, hemorrhoids - is nothing more than a varicose vein of the rectum. Therefore, in this case the use of sclerotherapy is justified and successful. Moreover, in the treatment of hemorrhoids sclerotherapy has been used for a long time - as much since the 19th century. At least that is widely used method of treating hemorrhoids and now. The success and effectiveness of sclerotherapy of hemorrhoids is based on modern sclerosing drugs and the use of special tools.
When sclerotherapy can be used?
The method is applicable sclerotherapy in patients with first, second and third stage of internal hemorrhoids as well as in the case of hemorrhoidal bleeding. In addition, sclerotherapy can be used in patients with hemorrhoids fourth stage in preparation for ligation of nodes with latex rings, or surgery.
Of course, like all other methods of hemorrhoid treatment, sclerotherapy is not without disadvantages and possible complications. This may be a pain, inflammation of the tissue surrounding the rectum - abscess, education oleogranulemy (Seal soft tissue). The reasons for this are usually associated with the violation of the rules of sclerosant. It is therefore important to perform sclerotherapy experienced proctologist, who specialized in this procedure that would avoid these complications during the procedure, as well as after it.
On what is based the principle of sclerotherapy? When injected into a vein sclerosing agent it interacts with the inner surface of the vein, which is lined with so-called endothelium. As a result, starts an inflammatory reaction, fibrosis, and sclerosing Vienna.
The advantages of sclerotherapy of hemorrhoids
Quite cheap and simple method for the treatment of hemorrhoids, which can be applied on an outpatient basis. This method does not require anesthesia or expensive long stay in hospital.
The effect of sclerotherapy shows quickly and lasts a long time. After approximately 7 - 10 days after the procedure, shrunken hemorrhoids fall off during normal defecation. The effect of sclerotherapy may take up to 12 months.
The method of sclerotherapy can be used in elderly patients, the veins are usually fragile and brittle.
During one session of sclerotherapy can handle multiple hemorrhoids.
The disadvantages of sclerotherapy of hemorrhoids
A large failure rate of the method for very large hemorrhoids, so in this case, we recommend using ligation of nodes with latex rings.
The possibility of recurrence of hemorrhoids after sclerotherapy. Sclerotherapy does not cure the patient from hemorrhoids - it just removes the hemorrhoids, which are varicose veins. Usually the effect of sclerotherapy "kept" up to 12 months.
Contraindications to sclerotherapy
Sclerotherapy is contraindicated in the following cases:
Acute phase nodes. The method of sclerotherapy is not recommended for use with third-degree hemorrhoids because of the risk of thrombosis nodes.
The large size of hemorrhoids. The effectiveness of sclerotherapy is quite low.
Pronounced bleeding. When combined with other hemorrhoid disease of the rectum, such as inflammatory diseases (Crohn's disease or ulcerative colitis), sclerotherapy can cause pronounced bleeding or ulceration of the mucosa of the colon.
Anal fissures or fistulas. These states are also contraindications for sclerotherapy.
Another contraindication to sclerotherapy is combined hemorrhoids, when there is no boundary between the external and internal hemorrhoids.
How is the method of sclerotherapy of hemorrhoids
Before the procedure, sclerotherapy is recommended that the patient has emptied bowels, bowel movements as soon after surgery can lead to the dispersal of sclerosing solution, which reduces the effectiveness of the procedure. The doctor chooses the concentration of sclerosing solution, depending on the size of nodes and stage hemorrhoids.
Sclerotherapy procedure itself is performed under local anesthesia, with a special anesthetic gel.
Sclerotherapy procedure is conducted with the patient on his back with legs given to the abdomen or in the jackknife position. In addition, patients with severe illness, he can lie on your side. The most comfortable position for both doctor and patient - this is when the latter lies on his back.
Before the procedure, the doctor treats an antiseptic hand - an alcoholic solution of chlorhexidine. Then processed by the skin around the anus, the same solution. Then in the lumen of the anal canal is entered anoscope, whose jaws open, then the same antiseptic solution which wetted gauze ball on time, handled the lumen of the rectum.
Once this after the introduction into the lumen of the rectum the doctor is a good review and become well become visible prolapses or bleeding internal hemorrhoids. Sclerosant is introduced into the hemorrhoid with a special syringe, which makes it easier.
Next, the doctor inserts a sclerosing solution into the internal hemorrhoid is located at 7 hours on the dial. Injection is carried out under the supervision of the eye. The tip of the mist at the same time should be in the submucosal layer of the rectum. Depending on what size of haemorrhoid, is introduced into the lumen of 0.5 to 2 ml of sclerosant.
Similarly, a second injection is carried out in the hemorrhoid is located at 11 hours on the dial. If sclerotherapy for bleeding hemorrhoids is held sclerosant is injected immediately into the bleeding site. To avoid the pain after the procedure, while the drug can be administered no more than two hemorrhoidal node. If necessary, repeat the procedure of sclerotherapy performed in 12 - 14 days after the previous one.
With the proper introduction of sclerosing agent is no pain, and hemorrhoid with uniform increases mucosal pallor over it. If the solution is introduced too deep in the muscular layer of the bowel, the patient is experiencing at this moment a sharp pain. In this case, the introduction of the drug is stopped and to avoid the development of the inflammatory process is carried out daily monitoring of the patient within 5 - 7 days.
The method of sclerotherapy is also used to stop hemorrhoidal bleeding. In this case, after cleansing enema into the lumen of the anal canal is entered anoscope and fixed so that its lumen was located bleeding hemorrhoid. After that, it introduces 1 - 2 ml of sclerosant, and then he gently pressed tupferom. Usually, after the end of this procedure occurs stop bleeding.
After the procedure, the patient should be sclerotherapy for about an hour to be in the clinic, sitting or standing. If he has not observed any negative effects, the patient can safely go home and lead a normal life. In this case, it does not have any physical limitations in the work, except for the fact that within 2 - 3 weeks is recommended to limit the heavy lifting. After 2 weeks, the patient should again come to the clinic, the doctor can assess the effectiveness of the treatment and decide on its continuation or termination.
Approximately 80% of patients after sclerotherapy marked pain. Typically, these pains unexpressed, and most pronounced in the day when the procedure is performed. Within a few days the pain disappear. If necessary, the doctor prescribes pain medication.
Possible complications of sclerotherapy
Serious complications of sclerotherapy are rare - about 0.02% of the case or a case of 5000 procedures performed sclerotherapy. Most often, they involve a violation of the rules of sclerotherapy.
Among the possible complications can be noted as follows:
Bleeding. Bleeding immediately after the injection can usually be associated with arterial puncture, which is suitable for hemorrhoidal node. This bleeding is usually easy to stop, pressing tupferom site. Bleeding in the late period may be due to the introduction of too large a solution or a solution to the introduction of the mucosa, rather than under it. This leads to a 1 - 2 weeks ulcers, from which is bleeding.
Pain. Although the pain and discomfort after sclerotherapy - a common phenomenon, pain syndrome is almost always associated with the wrong technique of sclerotherapy (often with the wrong place infusion). Injection of sclerosant to be held above the dentate line, which separates the anal canal from the rectum. In some cases, even when the place of injection solution is chosen correctly, the sclerosant can spread below the dentate line in the sensitive tissues. Therefore, as soon as the patient feels pain, the injection should be immediately discontinued. It should be remembered that the pain within 1 - 2 days after sclerotherapy - a common phenomenon and it is easily stopped by pain medications. The introduction of sclerosant into the vein. If the doctor feels that the solution is injected too easy or the patient noted pain in the liver or an unpleasant taste in your mouth, it means that the needle hit the anal vein and the injection should be immediately discontinued. This complication is not considered harmful to the body, despite the fact that the solution came in the bloodstream. But here is the effect of such injections should not wait.
The introduction of sclerosant into the prostate. Such a complication is possible in the event that the procedure is carried out sclerotherapy in a patient, a man suffering from BPH, the prostate gland when enlarged in size. Depending on how much solution was introduced into the prostate, and in what department, the severity of complications may range from slight to severe:
Retention of urine. This is the most common complication of injection of sclerosing solution into the prostate. Typically, the solution in the prostate tissue dissolves itself, although some patients require the introduction of the urinary catheter. Infertility. If you accidentally hit the solution in the seminal vesicle with its subsequent spread to the testicle, its function is greatly disturbed.
Prostatitis. This is an inflammation of the prostate. Is a manifestation of his frequent urination, pain and burning sensation when urinating, as well as an admixture of blood or pus in the urine.
The formation of an abscess. In too deep penetration of the needle into the prostate tissue can develop an abscess - a purulent inflammation.
The results of sclerotherapy of hemorrhoids
The main criteria by which one can judge the results of sclerotherapy, as in the infrared photocoagulation, can be called a cessation of bleeding and loss of hemorrhoids. The result is considered satisfactory if the loss of nodes has stopped, but retained a slight discharge of blood in the stool. Relapse, continued bleeding or loss of nodes are regarded as an unsatisfactory result of the procedure.
Note that the best results are obtained by sclerotherapy in patients with early stages of hemorrhoids, when the main symptom of the disease - is bleeding from the anus. The effectiveness of sclerotherapy in the third and fourth stages of hemorrhoids, when the main symptom - a loss of hemorrhoids, is markedly reduced.